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PubMed2005

Workload of window cleaners using ladders differing in rung separation.

The objective of the present study was to compare energetic workload, perceived exertion, perceived discomfort, safety, and mechanical load at lower limb joints among window cleaners during usage of extension ladders with 30 and 35 cm rung separation. Eleven healthy male professional window cleaners of short and tall stature participated in this study. No significant differences between 30 and 35 cm rung separation were observed for the energetic workload. Results concerning the perceived exertion, discomfort, and safety indicate that 35 cm rung separation is preferred. Based on the mechanical load at the hip, knee, and ankle during ascending and descending the ladder, 30 cm rung separation is preferable to 35 cm rung separation. It is advised to climb ladders with the knees inside the side rails of the ladder, but this seems only possible with 35 cm rung separation. Findings of the presents study suggest that overall, a 35 cm rung separation is marginally favourable while using extension ladders.

Adult↗

PubMed2005

Does a rolling floor reduce the physical work demands and workload, and increase the productivity of truck drivers handling packed goods?

A PCM rolling floor (RF) was developed to reduce the risk of musculoskeletal complaints among truck drivers. The RF can be used to move packed goods automatically in and out of the cargo space. The efficacy of this intervention on physical work demands, energetic and perceived workload and productivity was evaluated by comparing nine truck drivers working with a RF and a traditional, non-moving floor during a working day. Since the RF was not used during the loading process, no effects were found. The RF reduced the unloading process by 8 min, decreased the frequency of lifting and setting down goods by 24%, decreased the frequency of handling goods below knee level by 79%, and decreased the frequency of entering the cargo space by 45%. No effect was found on the energetic and perceived workload. The RF resulted in a small increase in productivity.

Adult↗

PubMed2005

Electromyography as a measure of peak and cumulative workload in intermediate care and its relationship to musculoskeletal injury: an exploratory ergonomic study.

Injury rates in Intermediate Care (IC) facilities are high and the factors related to these injuries are unclear. The objectives of this exploratory sub-study, which is part of a large multi-faceted study in 8 IC facilities are to: (1) evaluate EMG measured over a full-shift in the back and shoulders of 32 care aides (CAs) as an indicator of peak and cumulative workload (n = 4 x 8 facilities); investigate the relationship between EMG measures and injury indicators; and explore the relationship between EMG measures and other workload measurements. Lumbar EMG was converted to predicted cumulative spinal compression and ranged in CAs from 11.7 to 22.8 MNs with a mean of 16.4 MNs. Average compression was significantly different during different periods of the day (p < 0.001) with highest compression during pre-breakfast when CAs assist most with activities of daily living. Significant differences were found in average compression between low and high injury facilities for 3 of 5 periods of the day (p < 0.010). Peak compressions exceeding 3400 N occurred for very little of the workday (e.g. 11.25s during the 75 min period pre-breakfast). Peak neck/shoulder muscle activity is low (99% APDF ranged from 8.33% to 28% MVC). Peak and cumulative spinal compression were significantly correlated with lost-time and musculoskeletal injury rates as well as with total tasks observed in the CAs (p < 0.01). Perceived exertion was only correlated with peak compressions (p < 0.01). Facilities with low injury rates provided significantly more CAs (p < 0.01) to meet resident needs, and subsequently CAs performed fewer tasks, resulting in less peak and cumulative spinal loading over the day.

Back↗

PubMed2005

Interaction of biomechanical and morphological factors on shoulder workload in industrial paint work.

BACKGROUND: It is known that work-related musculoskeletal disorders are caused by multifactor operations of various risk factors. Among these, the association of these risk factors with pain symptoms and work-related musculoskeletal disorders have been reported in many studies in all typical manufacturing settings (Bernard, 1997). This study focuses on the automobile industry. METHODS: Twenty-nine paint area production workers of an automobile industry plant took part (age 37.7+/-8.2 years; seniority 6.9+/-6.2 years). Musculoskeletal morbidity was assessed through a questionnaire-administered interview and a clinical exam. Each workplace exposure was assessed by the observational rapid upper limb assessment method. The quantification of the workload on shoulders and wrists during the actual work task accomplishment was obtained through surface EMG. FINDINGS: Biomechanical exposure varied significantly between pain symptomatic and asymptomatic workers. It was the only estimator that could predict the risk of occurrence of musculoskeletal symptoms. Multifactor linear analysis showed that some linear and combined anthropometric characteristics could be associated to a higher workload on the shoulders and upper limbs. INTERPRETATION: The rigid external working conditions for employees with different morphologic characteristics, combined with demanding force application associated with the adoption of awkward postures for long and continuous periods of work time, impose constraints in accomplishment of the paint tasks. Additionally our results suggest that the same work task could present different musculoskeletal mechanical load for people with different anthropometrics.

Adult↗

PubMed2006

Trends in the on-call workload of radiologists.

AIM: To evaluate the radiologist on-call clinical workload of an inner-city acute teaching hospital. MATERIALS AND METHODS: Data were collected prospectively from a 9-week assessment of the workload of the radiologists on-call at our Trust. Data collection was undertaken using a questionnaire-based survey detailing the date and time of request, and where appropriate, the imaging examination performed. The referring clinician's grade and speciality were also recorded. The results obtained were compared with a similar study carried out in 1996. RESULTS: A total of 160 requests for out-of-hours imaging were received over the 9-week period. CONCLUSIONS: The figures indicate that on-call work is increasing with an approximate doubling of out-of-hours requests compared with the survey performed 7 years earlier.

After-Hours Care↗

PubMed2006

UK ward design: patient dependency, nursing workload, staffing and quality-an observational study.

BACKGROUND: There are important relationships between ward design, patient welfare and staff activity in the literature but studies seem not to have tested all the variables. Whether ward designs influence nursing structures, processes and outcomes, therefore, has not been fully answered. While studies provide helpful guidance, nursing efficiency and effectiveness implications are speculative. OBJECTIVES: To improve nursing efficiency and effectiveness by capitalizing on the best ward design features. SETTING: A database consisting of 375 UK wards, constructed for other research and development purposes, was revisited and reconfigured for the present study. The database was updated between 2003 and 2004. PARTICIPANTS: Of 390 wards approached, 375 generated usable data. METHOD: Patient dependency, nursing activity, workload, nursing quality and staffing data in the original database were obtained using mainly non-participation observation methods. Later, wards were classified in eight ways and differences between ward types examined. RESULTS: Patient dependency did not stand out in any ward type but as the literature predicted, direct patient care was higher in Nightingale wards. Racetrack ward nursing activity was also close to idyllic. Bay wards, owing to their greater occupancy peaks and troughs, had a propensity to generate heavier workloads. Time-out and down-time were not excessive in any ward type, and it is likely that ward leadership may be compensating for some variables' negative effects. Racetrack wards were considerably less-well staffed and grade-mix dilute and consequently the cheapest. Quality scores were higher in Nightingale wards-nurses' greater observation capability was a significant factor. Wards' central-core configurations also influenced nursing efficiency and effectiveness. CONCLUSIONS: Racetrack wards have an edge over other ward designs. However, replicating Nightingale conditions by, for example, equalising occupancy, throughput and staffing and maximising nurses' substations, could engender similar outcomes elsewhere.

Dependency, Psychological↗

PubMed2004

Excessive volume of trauma workload out of hours: is it really true?

To determine whether an excessive out of hours workload might contribute to the current lack of interest in trauma orthopaedics as a sub-specialty in the United Kingdom we reviewed data collected prospectively on 467 multiple trauma patients (ISS > 15) presenting to a teaching hospital over a 5 year period (January 1996-January 2001). Almost half of the patients (48.6%) presented between the hours of 18:00 and 08:00 with the trauma team called more frequently out of normal working hours. Two hundred and eleven (45.2%) patients underwent an operative procedure during their admission with an orthopaedic surgeon involved in the procedure in the majority of cases. Nearly half (41.5%) of these cases started between 18:00 and 08:00 with a larger portion (49.6%) finishing between these hours. A Consultant was the primary surgeon in 123 (82.0%) cases and involved in the majority of out of hours operating. Intensive care was required for 151 (32.3%) patients. The median hospital stay was 9 days (1-93). The out of hours workload for Orthopaedic consultants working in a busy teaching hospital is considerable. Planning issues need to be addressed to ensure that a career in trauma surgery is made attractive to current and future orthopaedic trainees.

Adolescent↗

PubMed2006

The effect of match standard and referee experience on the objective and subjective match workload of English Premier League referees.

The aim of the present study was to examine the effect of match standard and referee experience on the objective and subjective workload of referees during English Premier League and Football League soccer matches. We also examined the relationship between heart rate (HR) and ratings of perceived exertion (RPE) for assessing match intensity in soccer referees. Heart rate responses were recorded using short-range telemetry and RPE scores were collected using a 10-point scale. Analysis revealed a significant relationship between mean match HR and match RPE scores (r=0.485, p<0.05, n=18). There were significant differences in match HR (Premier League 83.6+/-2.6% maximal HR (HRmax) versus Football League 81.5+/-2.2%HRmax, p<0.05) and match RPE scores (Premier League 7.8+/-0.8 versus Football League 6.9+/-0.8, p<0.05) between standards of competition. Referee experience had no effect on match HR and RPE responses to Premier League and Football League matches. The results of the present study demonstrate the validity of using HR and RPE as a measure of global match intensity in soccer referees. Referee experience had no effect on the referees' objective and subjective match workload assessments, whereas match intensity was correlated to competition standard. These findings have implications for fitness preparation and evaluation in soccer referees. When progressing to a higher level of competition, referees should ensure that appropriate levels of fitness are developed in order to enable them to cope with an increase in physical match demands.

Adult↗

PubMed2004

Using mobile telephones: cognitive workload and attention resource allocation.

Driver distraction is recognized as being one of the central causes of road traffic incidents and mobile telephones are tangible devices (among many other electronic devices) that can distract the driver through changes in workload. Forty participants completed a motorway route characterized by a low level of road complexity in the form of vehicle handling and information processing. A peripheral detection task (PDT) was employed to gauge mental workload. We compared effects of conversation type (simple versus complex) and telephone mode (hands-free versus handheld) to baseline conditions. The participants' reaction times increased significantly when conversing but no benefit of hands-free units over handheld units on rural roads/motorways were found. Thus, in regard to mobile telephones, the content of the conversation was far more important for driving and driver distraction than the type of telephone when driving on a motorway or similar type of road. The more difficult and complex the conversation, the greater the possible negative effect on driver distraction.

Adult↗

PubMed2002

Effect of the number of two-wheeled containers at a gathering point on the energetic workload and work efficiency in refuse collecting.

The effect of the number of two-wheeled containers at a gathering point on the energetic workload and the work efficiency in refuse collecting was studied in order to design an optimal gathering point for two-wheeled containers. Three sizes of gathering points were investigated, i.e. with 2, 16 and 32 two-wheeled containers at a gathering point. The collecting of two-wheeled containers was simulated in a test circuit. The energetic workload was quantified by the parameters oxygen uptake (1 min(-1)), heart rate (beats min(-1)) and perceived exertion. The work efficiency was quantified as the time it took to collect 32 two-wheeled containers per time period. The maximum acceptable amount of two-wheeled containers collected during an 8-h working day was estimated using the energetic criterion of a maximum oxygen uptake of 30% VO2max. The size of the gathering point had no effect on the oxygen uptake, heart rate or perceived exertion. However, the number of two-wheeled containers per collecting period (work efficiency) and the maximum acceptable amount during an 8-h working day were higher in the conditions with 16 and 32 two-wheeled containers at a gathering point compared to the condition with the 2 two-wheeled containers at a gathering point.

Adult↗

PubMed1994

Radiology workload--a solution reviewed after 14 years' experience.

A method of controlling the radiological workload in a district general hospital, based on an estimation of the reasonable capacity of the department, was introduced in 1978. Measurement of the number of examinations performed compared with the estimated reasonable capacity shows that the method has been effective. An immediate 25% reduction in examinations was followed by a workload which varied between -4% and +16% of the capacity. An increase in the proportion of complex examinations in the period under review has been recognized. The method has encouraged referring doctors to exercise restraint and adopt guidelines, and helped persuade managers to increase capacity by appointing additional radiologists.

Appointments and Schedules↗

PubMed1999

Pediatric surgical workload during the past decade: impact on clinical activity and hospital finance at a children's hospital.

PURPOSE: The authors hypothesized that there are significant differences in clinical effort among the faculty of the various departments at an academic Children's Hospital, and that the clinical workload of surgeons has increased over the past decade. METHODS: A retrospective analysis of clinical practice and financial performance of the five departments (anesthesiology/critical care medicine, pathology, pediatrics, radiology, and surgery) at the Children's Hospital of Philadelphia from 1987 to 1997 was performed including clinical activity parameters (admissions, discharges, clinic visits), departmental faculty rosters, number of operations for the department of surgery as a whole and for individual surgeons in each pediatric surgical specialty, and professional and hospital financial data. RESULTS: Pediatric surgical specialists represented 15% of the total full-time physicians throughout the decade. In 1997, surgeons were responsible for 29% of hospital admissions, 28% of total outpatient visits at all clinical care sites, 37% of total professional fee revenue, 39% of hospital-based revenue, and a substantial portion of the hospital margin. Compared with 1987, the department of surgery in 1997 had a 60% increase in outpatient visits and a 58% increase in total operative case load (10,265 to 16,266). In terms of individual surgeon's workload during the decade, the outpatient visits per surgeon increased 45% and the operations per surgeon increased 27%, yet total reimbursement per surgeon slipped 16%. CONCLUSIONS: For the Children's Hospital that was studied, pediatric surgical specialists are doing more clinical work compared with 10 years ago, which may impact teaching, research, and administrative responsibilities. Surgeons have a greater responsibility than nonsurgeons for the hospital's clinical activity and financial health.

Academic Medical Centers↗

PubMedDate not supplied

Reducing the noneducational and nonclinical workload of the surgical resident; defining the role of the health technician.

PURPOSE: Recent controversy over excessive resident work hours has prompted surgical educators and program directors to search for more efficient methods to limit the nonclinical and noneducational workload of surgical residents. Health technicians were employed at a large Veteran's Administration Medical Center to allow residents more time for direct patient care in the clinics and wards and in educational activities. METHODS: In a two-week period, daily data cards were collected from each intern and health technician identifying total hours spent in work, operations, clinics, and conferences. Each intern recorded the number and type of tasks performed and those tasks assigned to the health technician. The number and type of task performed were tabulated and averaged for each health technician and physician. RESULTS: Each intern (n = 3) and health technician (n = 8) completed 100% of the required data forms. In a control survey, each intern worked a mean of 16.9 hours per weekday and 5.0 hours per weekend day. With the addition of the health technicians, interns worked 12.9 hours per weekday and 6.8 hours per weekend day (when the health technicians were not present). Following the addition of the health technicians, resident time in the operating room increased from 3.3 hours per week to 9.8 hours per week. Each health technician aided the intern by performing an average of 20.25 tasks per day. CONCLUSIONS: This study shows that health technicians can be effective in reducing the overall hours and workload of surgical residents and increasing time spent in the operating room. Consideration should be given to including the health technician as integral members of the health care team in the teaching hospital.

Allied Health Personnel↗

PubMed2001

A protocol for the reduction of systematic patient setup errors with minimal portal imaging workload.

PURPOSE: To evaluate a new off-line patient setup correction protocol that minimizes the required number of portal images and perform a comparison with currently applied protocols. METHODS AND MATERIALS: We compared two types of off-line protocols: (a) the widely applied shrinking action level (SAL) protocol, in which the setup error, averaged over the measured treatment fractions, is compared with a threshold that decreases with the number of measurements, to decide if a correction is necessary; and (b) a new "no-action-level" (NAL) protocol, which simply calculates the mean setup error over a fixed number of fractions, and always corrects for it. The performance of the protocols was evaluated by applying them to (a) a database of measured setup errors from 600 prostate patients (with, on average, 10 imaged fractions/patient) and (b) Monte Carlo-generated setup error distributions for various values of the population systematic and random errors. RESULTS: The NAL protocol achieved a significantly higher accuracy than the SAL protocol for a similar workload in terms of image acquisition and analysis, as well as in setup corrections. The SAL protocol required approximately three times more images than the NAL protocol to obtain the same reduction of systematic errors. Application of the NAL protocol to measured setup errors confirmed its efficacy in systematic error reduction in a real patient population. CONCLUSION: The NAL protocol performed much more efficiently than the SAL protocol for both actually measured and simulated setup data. The resulting decrease in required portal images not only reduces workload, but also dose to healthy tissue, if dedicated large fields are required for portal imaging (double exposure).

Algorithms↗

PubMed1997

An assessment of the Basic Treatment Equivalent (BTE) model as measure of radiotherapy workload.

Current methods of linear accelerator workload analysis in radiation oncology use patients per hour or fields per hour as the basic unit of measurement but fail to take account of the variations in complexity of different treatment techniques. The Basic Treatment Equivalent (BTE) model of productivity assessment has been derived as a potentially better measure of workload because it includes a complexity factor. This model has now been tested prospectively in ten radiation oncology departments in New South Wales and compared with the numbers of fields and patients per hour. Over a 4-week period there were 50,115 fields administrated in 18,466 fractions in 441 hours of machine time in ten radiation oncology departments. The average productivity results for all departments were 4.18 patients, 11.25 fields and 5.66 BTE per hour. When compared with patients per hour and fields per hour, there was less variability of BTE per patient per hour in all departments, suggesting that most departments deliver radiation therapy in a consistent way, which is not appropriately reflected in the numbers of fields or patients per hour. Departments that were able to treat a high number of patients or fields per hour were able to do so because they used less complicated techniques or had a less complicated casemix of patients. The BTE model allows for variations in the complexity of treatment techniques, is simple to apply, and is reproducible under different conditions in different departments. Following revision of the model, an Australasian study is now proposed. The confirmation of our findings will have significant implications for resource utilization comparisons, patient time allocations, waiting list estimates and cost-benefit analysis.

Efficiency↗

PubMed2003

Endovascular abdominal aortic aneurysm repair outside a tertiary referral centre: feasibility and impact upon workload.

In the UK, the majority of endovascular abdominal aortic aneurysm repairs (EVAR) are carried out in tertiary referral centres. We studied the feasibility and impact upon workload of an endovascular programme introduced into a district general hospital. Data was collected prospectively on all patients considered for EVAR since the inception of the programme in April 1999. Evaluation was by contrast enhanced CT scan followed by angiography if potentially suitable for EVAR. We recorded eligibility for EVAR, reasons for exclusion and the outcome of all patients irrespective of the mode of repair. Ninety patients were assessed over a 26-month period, nine of which did not complete the evaluation process. Sixty patients had one or more morphological features that precluded EVAR. Twenty-one patients were eligible for EVAR (26%), of which eighteen proceeded to EVAR, one awaits EVAR and two were below the treatment threshold (<5.5 cm). Seventeen had successful aneurysm exclusion and one required immediate conversion. One patient died within 30 days from gastrointestinal haemorrhage. There was one type-II endoleak at 1 month and to date we have encountered no ruptures or aneurysm-related deaths. Of the remaining 60 patients, 29 have proceeded to elective and 8 to urgent open repair with 2 deaths within 30 days in each group. EVAR is feasible outside tertiary referral centres and satisfactory early results can be achieved. An endovascular programme has important implications upon radiological and surgical workload. The operative mortality of patients undergoing open aortic repair remains acceptable following the introduction of an endovascular service into a district general hospital.

Aged↗

PubMed1995

The changing workload of a surgical unit with a vascular interest.

OBJECTIVES: To examine the changing relationship between general and vascular surgical workload on a vascular "firm", over a 6-year period. DESIGN: Retrospective review. SETTING: Leicester Royal Infirmary and Professorial Surgical Unit, U.K. 1987-1992. METHOD: Analysis of audit of all surgical admissions. Relation of vascular surgery to general surgery. RESULTS: There has been a slight decrease (5%) in the number of general surgical elective admissions. Overall, the number of general surgical admissions, both elective and emergency, show a slight increase of about 3%. In contrast the number of vascular admissions increased by 42%. Of the general surgical procedures carried out 75.9% were either minor or intermediate, whereas 92.5% of vascular procedures were coded as major or higher. There has been a three times increase in the number of carotid endarterectomies, a similar increase in the number of the femorodistal bypass grafts and a halving of the number of major amputations. There has also been a five times increase in the number of angioplasties carried out. CONCLUSIONS: Our figures show the progressive, rapid increase in vascular surgical workload, compared to general surgery, and the need for the continued expansion of vascular surgery as a speciality.

Abdominal Pain↗

PubMed1999

Stress and workload of men and women in high-ranking positions.

Psychological and physiological stress responses related to work and family were investigated in 21 female and 21 male managers and professional specialists in high-ranking positions. The main result was that both women and men experienced their jobs as challenging and stimulating, although almost all data indicated a more favorable situation for men than for women. In addition, women were more stressed by their greater unpaid workload and by a greater responsibility for duties related to home and family. Women had higher norepinephrine levels than men did, both during and after work, which reflected their greater workload. Women with children at home had significantly higher norepinephrine levels after work than did the other participants. The possible long-term health consequences of women's higher stress levels are discussed.

Adaptation, Psychological↗